HomeMy WebLinkAboutPermit Building 2005-1-16
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FIRE DAMAGE REPORT ~4 .IJ:fJ.oO
OR
ELECTRICAL HAZARD
FD-016
TO:
Building Department
Date:
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FROM: Springfield Fire Department
SUBJECT: Structural Damage to Building
Address or location of building
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Name of Owner
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Type of Building
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(Dwelling, Store, Warehouse, etc.)
Estimated value of building $ \ \ \) OO()
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Estimated loss to building $ ~D ffii)
Date of fire \[ 1[,,[ f) S
Location of damage to building _ [.0
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(Roof, Wall, Exterior, Interior, etc.)
Structural weakness as a result of the fire
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(Burned rafters, Beams, Joists, etc.)
Additional pertinent information
Electrical Hazard
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(Wiring, Outlets, etc.)
Signed J!.t krw
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V:\FD_FORMS\FD~16 FIRE DAMAGE REPORT.doc